COMMON QUESTIONS ABOUT KETAMINE
What Is Ketamine?
Ketamine was first developed as an anesthetic over 50 years ago. It is one of the most widely used medications in the world and is on the World Health Organization’s list of essential medicines. It has traditionally been used for pain control and anesthesia. Over the past several decades, research has discovered that at lower doses ketamine is highly effective in treating refractory depression. Even in cases of severe disease unresponsive to medical treatment, ketamine infusions are effective for about ⅔ of patients. Unlike many other conventional therapies, people have profound relief from their symptoms within hours of ketamine treatment.
How does ketamine work?
Studies have shown the benefit of ketamine in severe major depression, bipolar depression, and chronic pain. How ketamine causes such rapid and profound improvements in these disorders is still a subject of scientific study. The effects are complex, but appear to involve repairing of brain systems damaged by chronic stress by modulation of the glutamate receptor and increasing neuroplasticity (stimulating growth of connections between brain cells). Ketamine disrupts negative and maladaptive brain networks, allowing new positive connections to form in their place. Some have described this as analogous to rebooting a computer when it is no longer functioning properly.
Do I need a referral from a psychiatrist?
No. We do however ask that you obtain an evaluation and referral from a licensed mental health care professional (for example your psychologist or psychiatrist) or your primary care provider. It is important to have a screening exam and subsequent treatment evaluations by a medical professional in order to monitor your progress, and most importantly build upon the gains you have from your treatment to encourage long-lasting success. If you do need an evaluation, we can refer you to a recommended specialist.
What is the ketamine treatment like?
We follow the ketamine treatment protocol that has been studied most in the treatment of depression. This is commonly referred to as the NIMH (National Institute of Mental Health) protocol. Depending on the condition, we may tailor the treatment to your specific needs. The ketamine infusion takes about an hour. When you arrive, your vital signs will be checked, and an IV will be placed. Ketamine is then administered intravenously slowly over 40 minutes. After about 15 minutes, you may notice changes in your perception, altered thought patterns and the feeling of being in a dream-like state. By the end of the 40 minutes you may feel a sense of being outside of your body. Most people describe the experience as pleasant or euphoric. You will be awake, but people often find it difficult to communicate. We recommend resting comfortably with eyeshades and calming music of your choice.
How should I prepare for the treatment?
Since some people can have nausea after the infusion, it is best not to eat solid food for four hours before the treatment and clear liquids for two hours before the treatment. Do not use alcohol or any other non-prescription drugs on the day of treatment. You should wear comfortable clothes and consider bringing a playlist with meditative or calming music of your choice. Bring your own headphones if you prefer. Although most people feel little residual effects of the ketamine shortly after the infusion is stopped, a small minority have some dizziness or nausea. Therefore we recommend that you do not drive or operate machinery the day of treatment and require that you have arranged a ride home.
What are the success rates?
About ⅔ of people have a successful response to ketamine infusions for treatment-resistant depression. A response is generally considered a 50% reduction in symptom severity as measured by depression rating scales. About ⅓ of people have complete remission of their depression within 24 hours of the treatment. Similar success rates are observed for bipolar depression. This is a much better response than is seen with traditional antidepressants. Chronic pain can be more difficult to treat and the results vary depending on the condition and duration of disease.
What are the risks of Ketamine?
Ketamine is one of the most widely used medications in the world and has a very good safety profile. It is used daily on adults and children for sedation at doses up to 10 times the dose that we use for mood disorders and chronic pain. During the infusion, ketamine can cause a slight increase in blood pressure and heart rate. Ketamine causes most people to experience a pleasant euphoria, as well as positive changes in mood, cognition (thought processes) and perception. At higher doses, it can cause a feeling of an “out of body” experience. Although this can make some people anxious, most tolerate it well with adequate preparation and in the context of a safe and supportive setting. A small percentage of people have some nausea, which can be treated. The effects of ketamine wear off within about 15 minutes of stopping the infusion. Your doctor will discuss the risks and benefits in detail and answer all your questions before your treatment.
How will I know if the Ketamine worked for me?
Within one or two treatments, you should know if the ketamine treatment worked. People often feel significant improvements in mood within hours of the treatment, and this tends to peak within a day. With a positive response, the best evidence suggests continuing with a course of six infusions over 2-3 weeks to increase the durability of the effect, the NIMH (National Institute of Mental Health) protocol. For chronic pain, the typical treatment protocol will involve longer 5 hour daily treatments over 5 days. Subsequently, you can schedule maintenance (booster) treatments as needed according to your individual needs.
How long will results last?
The positive effect of a single ketamine treatment typically lasts anywhere from a few days to several weeks. The effect of the recommended full course of 6 infusions usually lasts from weeks to months. The effect can be sustained by doing a single booster infusion as needed and determined by your individual response. Some people even find that they no longer need to take antidepressants. To solidify the gains you have from your treatment and to ensure long-lasting success, it is important to continue to see your primary care provider or mental health care provider.
Are there contraindications to ketamine treatment?
There are very few conditions that are contraindications to ketamine treatment. You will undergo a complete and thorough medical evaluation prior to your treatment. Ketamine is not recommended people with schizophrenia, other types of psychosis or people currently in a manic phase of bipolar disorder. Ketamine is well tolerated in the setting of most medical comorbidities, but you should tell your doctor if you have uncontrolled high blood pressure, untreated thyroid disease, or severe heart, liver or kidney disease.
Do I have to stop my other medications?
There are very few medicines that interfere with ketamine treatment. You do not need to stop any of your antidepressants. However, it is important to tell your doctor about all of your current medications so that we can review for any possible interactions. Lamictal and benzodiazepines, such as Xanax and Ativan can decrease the effectiveness of the ketamine treatment. For optimal effect, you should be weaned off these prior to treatment, but any medication changes will be discussed in detail and be done in collaboration with your psychiatrist. Stimulants, such as Adderall or Ritalin should be held on treatment days.
Is Ketamine addictive?
Ketamine does not involve the reward systems typically present with other more addictive drugs in the brain and is generally not considered physically addictive. Some people do find the physical and psychological effects on mood, cognition and perception very pleasant and it has been known to be abused recreationally. However, at the low doses used in ketamine treatment, only given intermittently and under direct medical supervision, addiction is not a significant risk, and has not been observed in clinical studies.
Is the treatment covered under insurance?
Unfortunately no. Ketamine was first used as an anesthetic, and was approved by the FDA to be marketed as such. Ketamine’s use outside of that of an anesthetic is considered “off label,” and allowed when deemed medically appropriate by a physician.
What is the cost?
The initial 60 minute evaluation and screening exam is $200 plus tax. Ketamine infusions and follow-up treatments are $500 plus tax. Sliding scale is available for qualifying patients. The best evidence to extend the duration of ketamine’s benefit suggests continuing with a course of six infusions over two weeks, the National Institute of Mental Health protocol. Most patients then only require a single booster treatment every 1-3 months. Booster sessions as needed for chronic pain are usually a single day. For those patients who do find profound relief of their suffering with ketamine, they find the treatment to be very cost effective. We are also working to establish a grant program to help patients who cannot afford this treatment. Payment is due upon date of services. To respect the needs of our patients awaiting services, cancellations must be made more than 24 Hours in advance, without prior permission from clinic staff.
Do I have to do 6 sessions over two weeks or can customise it?
Up to half of all people with depression are not adequately treated by conventional therapies, or cannot tolerate the side effects of antidepressant medications. Many continue to suffer from what is called treatment-resistant depression. Today, depression is the leading cause of disability in the world, underscoring the great need for better treatment options.
Bipolar disorder can be a difficult illness to treat. Similar success rates are observed for treating bipolar depression as those with with unipolar depression. Scientific studies from the National Institute of Mental Health and academic centers throughout the world have found that over ⅔ of people have a successful response to ketamine infusions.
Chronic pain can be a severe and debilitating syndrome. It is often difficult to treat, and can be associated with co-morbid depression and the development of substance use disorders. Many treatments such as opiates and anti-inflammatory drugs also have significant side effects. Ketamine has been found effective in many types of chronic pain.
Substance use disorders are a serious public health problem. Alcohol accounts for over 3 million deaths every year, 6% of all deaths globally. Alcohol abuse is also directly related to a range of mental health disorders, medical diseases and injuries. Half of all trauma is associated with alcohol, as are over 70% of all suicide attempts.
Posttraumatic stress disorder (PTSD) causes significant morbidity and mortality (from suicide) globally and in the US. The lifetime prevalence of PTSD in the general population is approximately 5%. The incidence of PTSD is increased to approximately 20% among people who are exposed to neglect, abuse, violence, rape or military combat.